Uganda Clinical Guidelines 2023.pdf

THE REPUBLIC OF UGANDA MINISTRY OF HEALTH Uganda Clinical Guidelines 2023 National Guidelines for Management of Common Health Conditions Foreword The overall goal of Uganda’s health system is to provide accessible, equitable and quality services to the population, in order to promote a healthy and productive life, which is a necessary factor for achieving socio-economic growth and national development. Currently, the health system is faced with multiple challenges that include a high burden of infectious diseases that remain major causes of morbid- ity and mortality, such as HIV, malaria, tuberculosis, lower respiratory tract infections, malnutrition and meningitis. In addition, new threats keep emerging, for example, epidemics of hepatitis B, yellow fever, haemorrhagic fevers, COVID-19 and nodding disease. The increase of non-communicable conditions including diabetes, hypertension, heart diseases, cancer and mental disorders complicates the scenario. The push towards universal health coverage, including universal access to AntiRetroviral Therapy (ART) and particular attention to neonatal, child, adolescent and maternal health, is also placing more demands on a system with limited resources. To respond appropriately, the health system has to ensure high standards of quality and efficiency in service delivery. The Uganda Clinical Guide- lines manual helps to achieve these standards by presenting updated, practical, and useful information on the diagnosis and management of common health conditions in Uganda. It also provides a rational basis for an efficient procurement and supply system that ensures the availability of safe, efficacious, quality medicines and health supplies. The guidelines are based on principles of scientific evidence, cost effec- tiveness and prioritization of conditions to maximize the health benefit with limited resources. The regular update of clinical guidelines and essential medicines lists is one of the key interventions in the Health Sector Development Plan 2015-2020, to promote the appropriate use of health products and technologies. Uganda Clinical Guidelines 2023 I wish to thank all the members of the Ministry of Health Update Task Force, government parastatals, medical consultants, district health work- ers, the private sector, the Uganda Reproductive Maternal Child and Adolescent Health Improvement Project (URMCHIP) and development partners for their immense input in developing the 2023 UCG edition. Finally, I thank the consultancy firm, Zenith Solutions Limited, that coordinated the overall inputs that led to the successful development of this book. Dr. Aceng Jane Ruth Ocero Hon. Minister of Health III Uganda Clinical Guidelines 2023 Contents Foreword.......................................................................................II Preface........................................................................................ XXI Acknowledgements....................................................................... XXIII UCG Taskforce........................................................................... XXIII Contributors to the clinical chapters................................................ XXIV Administrative Support................................................................. XXXII Design/ Layout.......................................................................... XXXII Abbreviations.............................................................................. XXXIII Introduction to Uganda Clinical Guidelines 2023............................... XLIV 1 EMERGENCIES AND TRAUMA.....................................................1 1.1 Common Emergencies................................................................1 1.1.1 Anaphylactic Shock.........................................................................................1 1.1.2 Hypovolaemic Shock........................................................................................3 1.1.2.1 Hypvovolaemic Shock In Children.................................................................6 1.1.3 Dehydration....................................................................................................8 1.1.3.1 Dehydration in Children under 5 years...........................................................8 1.1.3.2 Dehydration in Older Children and Adults......................................................13 1.1.4 Fluids and Electrolytes Imbalances.................................................................15 1.1.4.1 IV Fluid management in children..................................................................19 1.1.5 Febrile Convulsions..........................................................................................22 1.1.6 Hypoglycaemia................................................................................................24 1.2 Trauma and Injuries..................................................................26 1.2.1 Bites and Stings..............................................................................................26 1.2.1.1 Snakebites.........................................................................................28 1.2.1.2 Insect Bites & Stings...........................................................................33 1.2.1.3 Animal and Human Bites...................................................................34 1.2.1.4 Rabies Post Exposure Prophylaxis.....................................................36 1.2.1.5 Rabies Vaccine Schedules....................................................................42 1.2.2 Fractures.......................................................................................................43 1.2.3 Burns..............................................................................................................45 1.2.4 Wounds...........................................................................................................52 1.2.5 Head Injuries...................................................................................................55 1.2.5.1 Traumatic Spinal Injury.......................................................................59 1.2.6 Sexual Assault/Rape......................................................................................60 IV Uganda Clinical Guidelines 2023 1.3 Poisoning................................................................................65 1.3.1 General Management of Poisoning...................................................................65 1.3.1.2 Removal and Elimination of Ingested Poison.......................................68 1.3.2 Acute Organophosphate Poisoning...................................................................70 1.3.3 Paraffin and Other Petroleum Products Poisoning..............................................72 1.3.4 Acetylsalicylic Acid (Aspirin) Poisoning..............................................................74 1.3.5 Paracetamol Poisoning.....................................................................................75 1.3.6 Iron Poisoning.................................................................................................76 1.3.7 Carbon Monoxide Poisoning............................................................................77 1.3.8 Barbiturate Poisoning.......................................................................................78 1.3.9 Opioid Poisoning.............................................................................................79 1.3.10 Warfarin Poisoning........................................................................................80 1.3.11 Methyl Alcohol (Methanol) Poisoning..............................................................81 1.3.12 Alcohol (Ethanol) Poisoning..........................................................................82 1.3.12.1 Acute Alcohol Poisoning....................................................................82 1.3.12.2 Chronic Alcohol Poisoning.................................................................84 1.3.13 Food Poisoning.............................................................................................85 1.4 Hypoxeamia Management and Oxygen Therapy Guidelines.............87 2 INFECTIOUS DISEASES..............................................................95 2.1 Bacterial Infections...................................................................95 2.1.1 Anthrax..........................................................................................................95 2.1.2 Brucellosis.......................................................................................................97 2.1.3 Diphtheria......................................................................................................100 2.1.4 Leprosy/Hansens disease..............................................................................101 2.1.5 Meningitis......................................................................................................107 2.1.5.1 Neonatal Meningitis............................................................................111 2.1.5.2 Cryptococcal Meningitis........................................................................ 2.1.5.3 TB Meningitis....................................................................................113 2.1.6 Plague............................................................................................................113 2.1.7 Septicaemia...................................................................................................115 2.1.7.1 Neonatal Septicaemia.........................................................................117 2.1.7.2 Septic Shock Management, In Adults.................................................118 2.1.8 Tetanus..........................................................................................................119 2.1.8.1 Neonatal Tetanus...............................................................................123 2.1.9 Typhoid Fever (Enteric Fever).........................................................................124 2.1.10 Typhus Fever................................................................................................126 V Uganda Clinical Guidelines 2023 2.2 Fungal Infections.....................................................................128 2.2.1 Candidiasis.....................................................................................................128 2.3 Viral Infections........................................................................130 2.3.1 Avian Influenza............................................................................................130 2.3.2 Chicken pox...................................................................................................133 2.3.3 Measles..........................................................................................................134 2.3.4 Poliomyelitis...................................................................................................136 2.3.5 Rabies............................................................................................................138 2.3.6 Viral Haemorrhagic Fevers..............................................................................140 2.3.6.1 Ebola and Marburg.............................................................................140 2.3.6.2 Yellow Fever......................................................................................143 2.3.7 COVID-19 Disease.........................................................................................144 2.4 Helminthes Parasites................................................................150 2.4.1 Intestinal Worms...........................................................................................150 2.4.1.1 Taeniasis (Tapeworm).........................................................................153 2.4.2 Echinococcosis (Hydatid Disease)...................................................................154 2.4.3 Dracunculiasis (Guinea Worm).........................................................................156 2.4.4 Lymphatic Filariasis........................................................................................157 2.4.5 Onchocerciasis (River Blindness)......................................................................159 2.4.6 Schistosomiasis (Bilharziasis)............................................................................161 2.5 Protozoal Parasites..................................................................162 2.5.1 Leishmaniasis.................................................................................................162 2.5.2 Malaria...........................................................................................................164 2.5.2.1 Uncomplicated Malaria.......................................................................165 2.5.2.2 Complicated/Severe Malaria...............................................................166 2.5.3.3 Management of Complications of Severe Malaria.................................175 2.5.3.4 Malaria Prophylaxis............................................................................179 2.5.3.5 Malaria Prevention and Control...........................................................180 2.5.4 Human African Trypanosomiasis (Sleeping Sickness).....................................181 3 HIV/AIDS AND SEXUALLY TRANSMITTED INFECTIONS.............186 3.1 HIV Infection And Acquired Immunodeficiency Syndrome (AIDS).. 186 3.1.1 Clinical Features of HIV.................................................................................187 3.1.2 Diagnosis and Investigations of HIV.................................................................190 3.1.3 Measures before ARV Treatment.....................................................................197 3.1.4 General Principles of Antiretroviral Treatment (ART)........................................200 VI Uganda Clinical Guidelines 2023 3.1.5 Recommended First Line Regimens.................................................................206 3.1.6 Monitoring of ART.........................................................................................211 3.1.7 ARV Toxicity..................................................................................................218 3.1.8 Recommended Second Line Regimens...........................................................222 3.1.9 Mother-to-Child Transmission of HIV...............................................................229 3.1.9.1 Management of HIV Positive Pregnant Mother....................................231 Key Interventions for eMTCT...................................................................................231 3.1.9.2 HIV-exposed infant care services........................................................239 3.1.9.3 Care of HIV Exposed Infant................................................................248 3.1.10 Opportunistic Infections In HIV....................................................................252 3.1.10.1 Tuberculosis and HIV Co-Infection....................................................252 3.1.10.2 Cryptococcal Meningitis...................................................................255 3.1.10.3 Hepatitis B and HIV Co-Infection.....................................................261 3.1.10.4 Pneumocystis Pneumonia.................................................................263 3.1.10.5 Other Diseases.................................................................................264 3.1.11 Prevention of HIV........................................................................................264 3.1.11.1 Post-Exposure Prophylaxis................................................................265 3.1.11.2 Pre-Exposure Prophylaxis (PrEP).......................................................269 3.1.12....................................................................................................................... 3.2 Sexually Transmitted Infections (STI)..........................................276 3.2.1 Urethral Discharge Syndrome (Male)...............................................................276 3.2.2 Abnormal Vaginal Discharge Syndrome...........................................................279 3.2.3 Pelvic Inflammatory Disease (PID)....................................................................283 3.2.4 Genital Ulcer Disease (GUD) Syndrome..................................................283 3.2.5 Inguinal Swelling (Bubo).........................................................................286 3.2.6 Genital Warts........................................................................................288 3.2.7 Syphilis.................................................................................................290 3.2.8 Other Genital Infections..................................................................................292 3.2.8.1 Balanitis......................................................................................................292 3.2.8.2 Painful Scrotal Swelling................................................................................293 3.2.9 Congenital STI Syndromes..............................................................................294 3.2.9.1 Neonatal Conjunctivitis (Ophthalmia Neonatorum)........................................294 3.2.9.2 Congenital Syphilis......................................................................................295 4 CARDIOVASCULAR DISEASES...................................................298 4.1.1 Deep Vein Thrombosis/Pulmonary Embolism (DVT/P)....................................298 4.1.2 Infective Endocarditis......................................................................................301 4.1.3 Heart Failure..................................................................................................304 4.1.4 Pulmonary Oedema........................................................................................308 VII Uganda Clinical Guidelines 2023 4.1.5 Atrial Fibrillation.............................................................................................309 4.1.6 Hypertension.................................................................................................311 4.1.6.1 Hypertensive Emergencies and urgency............................................316 4.1.7 Ischaemic Heart Disease (Coronary Heart Disease)...........................................317 4.1.8 Pericarditis.....................................................................................................320 4.1.9 Rheumatic Fever.............................................................................................322 4.1.10 Rheumatic Heart Disease..............................................................................325 4.1.11 Stroke..........................................................................................................326 5 RESPIRATORY DISEASES..........................................................329 5.1 Non-Infectious Respiratory Diseases...........................................329 5.1.1 Asthma.........................................................................................................329 5.1.1.1 Acute Asthma....................................................................................331 5.1.1.2 Chronic Asthma.................................................................................337 5.1.2 Chronic Obstructive Pulmonary Disease (COPD)..............................................340 5.2 Infectious Respiratory Diseases..................................................344 5.2.1 Bronchiolitis...................................................................................................344 5.2.2 Acute Bronchitis.............................................................................................346 5.2.3 Coryza (Common Cold)..................................................................................347 5.2.4 Acute Epiglottitis............................................................................................349 5.2.5 Influenza (” Flu”).............................................................................................350 5.2.6 Laryngitis......................................................................................................352 5.2.7 Acute Laryngotracheobronchitis (Croup).......................................................353 5.2.8 Pertussis (Whooping Cough)............................................................................355 5.2.9 Pneumonia.....................................................................................................357 5.2.9.1 Pneumonia in an Infant (up to 2 months)...........................................358 5.2.9.2 Pneumonia in a Child of 2 months-5 years..........................................360 5.2.9.3 Pneumonia in Children > 5 years and adults........................................363 5.2.9.4 Pneumonia by Specific Organisms......................................................364 5.2.9.5 Pneumocystis jirovecii Pneumonia......................................................365 5.2.9.6 Lung Abscess.....................................................................................366 5.3 Tuberculosis (Tb).....................................................................367 5.3.1 Definition, Clinical Features and Diagnosis of TB.............................................367 5.3.1.1 Tuberculosis in Children and adolescents......................................................373 5.3.1.2 Drug-Resistant TB.......................................................................................374 5.3.1.3 Post-TB patient management......................................................................375 5.3.2 Management of TB.........................................................................................376 5.3.2.1 Anti-TB Drugs Side Effects..........................................................................382 VIII Uganda Clinical Guidelines 2023 5.3.2.2 Prevention and Infection Control of TB.........................................................385 5.3.2.3 Tuberculosis Preventive Treatment................................................................386 5.3.2.5 TB Preventive Treatment Dosing Chart.........................................................388 6 GASTROINTESTINAL AND HEPATIC DISEASES..........................394 6.1 Gastrointestinal Emergencies.....................................................394 6.1.1 Appendicitis (Acute)........................................................................................394 6.1.2 Acute Pancreatitis..........................................................................................395 6.1.3 Upper Gastrointestinal Bleeding.....................................................................400 6.1.4 Peritonitis.......................................................................................................401 6.1.5 Diarrhoea.......................................................................................................403 6.2 Gastrointestinal Infections........................................................405 6.2.1 Amoebiasis.....................................................................................................405 6.2.2 Bacillary Dysentery (Shigellosis).......................................................................407 6.2.4 Giardiasis.......................................................................................................409 6.3 Gastrointestinal Disorders.........................................................410 6.3.1 Dysphagia......................................................................................................410 6.3.2 Dyspepsia.....................................................................................................412 6.3.3 Gastroesophageal Reflux Disease (GERD/GORD)............................................413 6.3.4 Gastritis.........................................................................................................415 6.3.5 Peptic Ulcer Disease (PUD).............................................................................417 6.3.6 Chronic Pancreatitis........................................................................................419 6.4 Anorectal Disorders...........................................................................................421 6.4.1 Constipation..................................................................................................421 6.4.2 Haemorrhoids (Piles) and Anal Fissures...........................................................423 6.5 Hepatic and Biliary Diseases......................................................425 6.5.1 Viral Hepatitis................................................................................................425 6.5.1.1 Acute Hepatitis..................................................................................425 6.5.1.2 Chronic Hepatitis...............................................................................427 6.5.2 Chronic Hepatitis B Infection..........................................................................428 6.5.2.1 Inactive Hepatitis B Carriers...............................................................430 6.5.2.2 Pregnant Mother HbsAg Positive.........................................................430 6.5.3 Chronic Hepatitis C Infection.................................................................431 6.5.4 Liver Cirrhosis................................................................................................431 6.5.4.1 Ascites...............................................................................................434 6.5.4.2 Spontaneous Bacterial Peritonitis (SBP)..............................................436 6.5.4.3 Hepatic Encephalopathy (HE)............................................................437 IX Uganda Clinical Guidelines 2023 6.5.4.2 Oesophageal Varices..........................................................................439 6.5.4.3 Hepatorenal Syndrome.......................................................................440 6.5.4.4 Hepatocellular Carcinoma...................................................................440 6.5.5 Hepatic Schistosomiasis..................................................................................441 6.5.6 Drug-Induced Liver Injury................................................................................442 6.5.7 Jaundice (Hyperbilirubinemia)..........................................................................443 6.5.8 Gallstones/Biliary Colic..................................................................................444 6.5.9 Acute Cholecystitis/Cholangitis.......................................................................445 7 RENAL AND URINARY DISEASES..............................................448 7.1 Renal Diseases........................................................................448 7.1.1 Acute Renal Failure.........................................................................................448 7.1.2 Chronic Kidney Disease (CKD)........................................................................450 7.1.3 Use of Drugs in Renal Failure..........................................................................453 7.1.4 Glomerulonephritis.........................................................................................454 7.1.5 Nephrotic Syndrome.......................................................................................457 7.2 Urological Diseases..................................................................458 7.2.1 Acute Cystitis.................................................................................................458 7.2.2 Acute Pyelonephritis.......................................................................................460 7.2.3 Prostatitis.......................................................................................................463 7.2.4 Renal Colic.....................................................................................................464 7.2.5 Benign Prostatic Hyperplasia..........................................................................465 7.2.6 Bladder Outlet Obstruction..............................................................................466 7.2.7 Urine Incontinence.........................................................................................467 8 ENDOCRINE AND METABOLIC DISEASES..................................468 8.1.1 Addison’s Disease...........................................................................................468 8.1.2 Cushing’s Syndrome.......................................................................................470 8.1.3 Diabetes Mellitus............................................................................................471 8.1.4 Diabetic Ketoacidosis and Hyperosmolar Hyperglycaemic State........................478 8.1.5 Goitre............................................................................................................481 8.1.6 Hyperthyroidism.............................................................................................482 8.1.7 Hypothyroidism..............................................................................................484 8.1.8. Central precocious puberty............................................................................486 X Uganda Clinical Guidelines 2023 9 MENTAL, NEUROLOGICAL AND SUBSTANCE USE DISORDERS..488 9.1 Neurological Disorders..............................................................488 9.1.1 Epilepsy.........................................................................................................488 9.1.2 Nodding Disease............................................................................................496 9.1.3 Headache.......................................................................................................497 9.1.3.1 Migraine............................................................................................498 9.1.4 Dementia.......................................................................................................499 9.1.5 Parkinsonism..................................................................................................502 9.1.6 Delirium (Acute Confusional State)...................................................................504 9.2 Psychiatric And Substance Use Disorders....................................506 9.2.1 Anxiety..........................................................................................................506 9.2.2 Depression.....................................................................................................508 9.2.2.1 Postnatal Depression..........................................................................512 9.2.2.2 Suicidal Behaviour/Self Harm...........................................................511 9.2.3 Bipolar Disorder (Mania).................................................................................515 9.2.4 Psychosis.......................................................................................................520 9.2.4.1 Postnatal Psychosis.............................................................................522 9.2 Psychiatric And Substance Use Disorders....................................524 9.2.1 Anxiety..........................................................................................................524 9.2.2 Depression.....................................................................................................526 9.2.2.1 Postnatal Depression...................................................................................530 9.2.2.2 Suicidal Behaviour/Self Harm......................................................................531 9.2.3 Bipolar Disorder (Mania).................................................................................533 9.2.4 Psychosis.......................................................................................................538 9.1.1.1 Postnatal Psychosis......................................................................................541 9.1.1 Alcohol Use Disorders....................................................................................543 9.1.2 Substance Abuse............................................................................................547 9.1.3 Childhood Behavioural Disorders....................................................................550 9.1.4 Childhood Developmental Disorders................................................................552 10 MUSCULOSKELETAL AND JOINT DISEASES............................554 10.1 Infections..............................................................................554 10.1.1 Pyogenic Arthritis (Septic Arthritis)................................................................554 10.1.2 Osteomyelitis................................................................................................556 10.1.3 Pyomyositis..................................................................................................559 XI Uganda Clinical Guidelines 2023 10.1.4 Tuberculosis of the Spine (Pott’s Disease).......................................................560 10.2 Inflammatory/Degenerative Disorders.......................................562 10.2.1 Rheumatoid Arthritis....................................................................................562 10.2.2 Gout Arhthritis.............................................................................................564 10.2.3 Osteoarthritis...............................................................................................566 11 BLOOD DISEASES AND BLOOD TRANSFUSION GUIDELINES....568 11.1 Blood Disorders.....................................................................568 11.1.1 Anaemia...........................................................................................568 11.1.1.1 Iron Deficiency Anaemia...................................................................571 11.1.1.2 Megaloblastic Anaemia....................................................................573 11.1.1.3 Normocytic Anaemia......................................................................575 11.1.2 Bleeding Disorders.............................................................................577 11.1.3 Sickle Cell Disease..............................................................................579 11.2 Blood and Blood Products.......................................................588 11.2.1 General Principles of Good Clinical Practice in Transfusion Medicine.....589 11.2.2 Blood and Blood Products: Characteristics and Indications..................590 11.2.2.1 Whole Blood..................................................................................590 11.2.2.2 Red Cell Concentrates (packed red cells)..........................................591 11.2.2.3 Clinical Indications for Blood Transfusion.........................................592 11.2.3 Adverse Reactions following Transfusion......................................................595 11.2.3.1 Acute Transfusion Reactions............................................................598 12 ONCOLOGY...........................................................................602 12.1 Introduction..........................................................................602 12.1.1 Special Groups at Increased Risk of Cancer...................................................602 12.1.2 Early Signs and Symptoms............................................................................603 12.1.2.1 Urgent Signs and Symptoms.............................................................605 12.2 Prevention of Cancer.............................................................605 12.2.1 Primary Prevention.....................................................................................605 12.2.1.1 Control of Risk Factors.....................................................................606 12.2.2 Secondary Prevention.........................................................................609 12.3 Common Cancers..................................................................612 12.3.1 Common Cancers in Children.......................................................................612 XII Uganda Clinical Guidelines 2023 1.1.1 Common Cancers in Adults............................................................................614 13 PALLIATIVE CARE..................................................................621 13.1 Pain................................................................................................................622 13.1.1 Clinical Features and Investigations................................................................623 13.1.2 Nociceptive Pain Management.............................................................623 13.1.2.1 Pain Management In Adults..........................................................625 13.1.2.3 Pain Management In Children...........................................................627 13.1.3 Neuropathic Pain.........................................................................................631 13.1.4 Back or Bone Pain.......................................................................................632 13.2 Other Conditions In Palliative Care...........................................633 13.2.1 Breathlessness..............................................................................................633 13.2.2 Nausea and Vomiting....................................................................................634 13.2.3 Pressure Ulcer (Decubitus Ulcers)...................................................................634 13.2.4 Fungating Wounds........................................................................................635 13.2.5 Anorexia and Cachexia........................................................................636 13.2.6 Hiccup................................................................................................637 13.2.7 Dry or Painful Mouth..........................................................................638 13.2.8 Other Symptoms.................................................................................639 13.2.9 End of Life Care..................................................................................639 14 GYNECOLOGICAL CONDITIONS..............................................643 14.1.1 Dysmenorrhoea............................................................................................643 14.1.2 Pelvic Inflammatory Disease (PID).................................................................644 14.1.3 Abnormal Uterine Bleeding..........................................................................647 14.1.4 Menopause...................................................................................................649 15 FAMILY PLANNING (FP)...........................................................651 15.1 Key steps to be followed in provision of FP services...................651 15.1.1 Provide Information about FP........................................................................652 15.1.2 Counsel High-Risk Clients.............................................................................653 15.1.3 Pre-Conception Care with Clients Who Desire to Conceive...........................654 15.1.4 Discuss with PLW HIV Special Consideration for HIV Transmission...............654 15.1.5 Educate and Counsel Clients to Make Informed Choice of FP Method............654 15.1.6 Obtain and Record Client History.......................................................655 15.1.7 Perform a Physical Assessment...........................................................657 15.1.8 Perform a Pelvic Examination.............................................................658 15.1.9 Manage Client for Chosen FP Method.................................................658 XIII Uganda Clinical Guidelines 2023 15.1.10 Summary of Medical Eligibility for Contraceptives..............................659 15.2 Overview Of Key Contraceptive Methods.................................664 15.2.1 Condom (Male).............................................................................................664 15.2.2 Condom (Female).........................................................................................666 15.2.3 Combined Oral Contraceptive Pill (COC)............................................667 15.2.4 Progestogen-Only Pill (POP)................................................................671 15.2.5 Injectable Progestogen-Only Contraceptive...........................................674 15.2.6 Progestogen-Only Sub-Dermal Implant.................................................679 15.2.7 Emergency Contraception (Pill and IUD)..............................................683 15.2.8 Intrauterine Device (IUD)...............................................................................685 15.2.9 Natural FP: Cervical Mucus Method (CMM) and Moon Beads.........................688 15.2.10 Natural FP: Lactational Amenorrhoea Method (LAM)...................................689 15.2.11 Surgical Contraception for Men: Vasectomy.................................................690 15.2.12 Surgical Contraception for Women: Tubal Ligation......................................691 16 OBSTETRIC CONDITIONS........................................................693 16.1 Antenatal Care (ANC)............................................................693 16.1.1 Goal-Oriented Antenatal Care Protocol..........................................................693 16.1.2 Management of Common Complaints during Pregnancy...............................698 16.1.3 High Risk Pregnancy (HRP)...........................................................................700 16.2 Management Of Selected Conditions in Pregnancy....................701 16.2.1 Anaemia in Pregnancy.................................................................................701 16.2.2 Pregnancy and HIV Infection.......................................................................704 16.2.2.1 Care for HIV Positive Women (eMTCT)............................................705 16.2.2.2 Counselling for HIV Positive Mothers................................................706 16.2.3 Chronic Hypertension in Pregnancy..............................................................708 16.2.4 Malaria in Pregnancy.................................................................................709 16.2.5 Diabetes in Pregnancy.................................................................................711 16.2.6 Urinary Tract Infections in Pregnancy...........................................................713 16.3 Antenatal Complications..................................................................................714 16.3.1 Hyperemesis Gravidarum....................................................................714 16.3.2 Vaginal Bleeding in Early Pregnancy/ Abortion...................................715 16.3.3 Ectopic Pregnancy...............................................................................719 16.3.4 Premature Rupture of Membranes (PROM & PPROM).........................721 16.3.5 Chorioamnionitis................................................................................725 16.3.6 Antepartum Haemorrhage (APH) – Abruptio Placentae and Placenta Praevia.. 726 16.3.7 Pre-Eclampsia...............................................................................................729 XIV Uganda Clinical Guidelines 2023 16.3.8 Eclampsia...................................................................................................733 16.4 Labour, Delivery and Acute Complications................................737 16.4.1 Normal Labour and Delivery................................................................737 16.4.2 Induction of Labour.............................................................................740 16.4.3 Obstructed Labour........................................................................................742 16.4.4 Ruptured Uterus...........................................................................................743 16.4.5 Retained Placenta.........................................................................................745 16.4.6 Postpartum Haemorrhage (PPH)...................................................................746 16.4.7 Puerperal Fever/Sepsis...............................................................................750 16.4.8 Care of Mother and Baby Immediately After Delivery....................................752 16.4.8.1 Care of Mother Immediately After Delivery..................................................753 16.4.8.2 Care of Baby Immediately After Delivery....................................................754 16.5 Essential Care of the Newborn................................................756 16.5.1 Newborn Resuscitation.................................................................................756 16.5.2 General Care of Newborn After Delivery.......................................................759 16.5.3 Extra Care of Small Babies or Twins in the First Days of Life.......................761 16.5.4 Newborn Hygiene at Home.........................................................................763 16.6 Postpartum Conditions...........................................................764 16.6.1 Postpartum Care..........................................................................................764 16.6.1.1 Postpartum Counselling....................................................................764 16.5.1.2 Postpartum Examination of the Mother Up to 6 Weeks......................767 16.6.2 Postnatal Depression....................................................................................781 16.6.3 Mastitis/Breast Abscess................................................................................782 16.6.4 Obstetric Fistula............................................................................................784 16.7 Intrauterine Fetal Demise (IUFD) Or Fetal Death In Utero (FDIU)..788 17 CHILDHOOD ILLNESS.............................................................796 17.1 Sick Newborn.......................................................................796 17.1.1 Newborn Examination/Danger Signs.............................................................796 17.1.2 Assess for Special Treatment Needs, Local Infection, and Jaundice.................801 17.2 Sick Young Infant Age Up To 2 Months....................................806 17.2.1 Check for Very Severe Disease and Local Bacterial Infection...........................807 17.2.2 Check for Jaundice.......................................................................................810 17.2.3 Check for Diarrhoea/Dehydration.................................................................811 XV Uganda Clinical Guidelines 2023 17.2.4 Check for HIV Infection................................................................................815 17.2.5 Check for Feeding Problem or Low Weight-for-Age.......................................817 17.2.5.1 All Young Infants Except HIV-exposed Infants Not Breastfed..............817 17.2.5.2 HIV-exposed Non Breastfeeding Infants...........................................820 17.2.6 Check Young Infant’s Immunization Status....................................................823 17.2.7 Assess Other Problems................................................................................823 17.2.8 Assess Mother’s Health Needs.....................................................................823 17.2.9 Summary of IMNCI Medicines Used for Young Infants...................................823 117.2.10 Counsel the Mother.................................................................................824 17.3 Sick Child Age 2 Months to 5 Years........................................825 17.3.21 Check for General Danger Signs................................................................826 17.3.2 Check for Cough or Difficult Breathing.........................................................827 17.3.3 Child Has Diarrhoea....................................................................................830 17.3.4 Check for Fever...........................................................................................834 17.3.5 Check for Ear Problem................................................................................841 17.3.6 Check for Malnutrition and Feeding Problems...............................................842 17.3.7 Check for Anaemia......................................................................................846 17.3.8 Check Immunization, Vitamin A, Deworming................................................850 17.3.9 Assess Other Problems................................................................................850 17.3.10 Summary of Medicines Used......................................................................850 17.3.10.1 Medicines Used Only in Health Centers.........................................851 17.3.10.2 Medicines for Home Use..............................................................852 17.3.10.3 Treatment of Local Infections at Home...........................................856 17.3.11 Counsel the Mother...................................................................................858 17.3.12.1 Feeding Recommendation during Illness.........................................858 17.3.12.2 Assessing Appetite and Feeding.....................................................858 17.3.12.3 Feeding Recommendations...........................................................860 17.3.12.4 Counselling for Feeding Problems.................................................863 17.3.12.5 Mother’s Health............................................................................865 17.4 Integrated Community Case Management.................................866 17.5 Child Growth Weight Standards Charts....................................868 18 IMMUNIZATION......................................................................875 18.1 Routine Childhood Vaccination...............................................875 18.1.1 National Immunization Schedule..................................................................875 18.1.2 Hepatitis B Vaccination...............................................................................881 18.1.3 Yellow Fever Vaccination.............................................................................882 18.1.4 Tetanus Prevention......................................................................................882 XVI Uganda Clinical Guidelines 2023 18.2.3.1 Prophylaxis Against Neonatal Tetanus..............................................883 18.2.4 Vaccination against COVID-19.....................................................................885 19 NUTRITION............................................................................887 19.1 Nutrition Guidelines In Special Populations...............................887 19.1.1 Infant and Young Child Feeding (IYCF).........................................................887 19.1.2 Nutrition in HIV/AIDS.................................................................................888 19.1.3 Nutrition in Diabetes....................................................................................889 19.2 Malnutrition.........................................................................890 19.2.1 Introduction on Malnutrition.........................................................................890 19.2.1.1 Classification of Malnutrition......................................................................892 19.2.1.2 Assessing Malnutrition in Children 6 months to 5 years...............................893 19.2.2 Management of Acute Malnutrition in Children............................................897 19.2.2.1 Management of Moderate Acute Malnutrition....................................897 19.2.2.2 Management of Uncomplicated Severe Acute Malnutrition.................898 19.2.2.3 Management of Complicated Severe Acute Malnutrition.....................899 19.2.2.4 Treatment of Associated Conditions..................................................914 19.2.2.5 Discharge from Nutritional Programme.............................................916 19.2.3 SAM in Infants Less than 6 Months.............................................................918 19.2.4 Obesity and Overweight..............................................................................919 20 EYE CONDITIONS...................................................................923 20.1 Infections And Inflammatory Eye Conditions.............................923 20.1.1 Notes on Use of Eye Preparations.................................................................923 20.1.2 Conjunctivitis (“Red Eye”).............................................................................923 20.1.3 Stye (Hordeolum).........................................................................................925 20.1.4 Trachoma.....................................................................................................926 20.1.5 Keratitis.......................................................................................................927 20.1.6 Uveitis.........................................................................................................928 20.1.7 Orbital Cellulitis............................................................................................930 20.1.8 Postoperative Endophthalmitis.......................................................................931 20.1.9 Xerophthalmia..............................................................................................932 20.2 Decreased or Reduced Vision Conditions.........................................................933 20.2.1 Cataract..............................................................................................933 20.2.1.1 Paediatric Cataract...........................................................................934 20.2.2 Glaucoma...........................................................................................935 20.2.3 Diabetic Retinopathy...........................................................................936 XVII Uganda Clinical Guidelines 2023 20.2.4 Refractive Errors................................................................................937 20.2.5 Low Vision.........................................................................................939 20.2.5.1 Vision Loss......................................................................................939 20.3 Trauma and Injuries to the Eye................................................941 20.3.1 Foreign Body in the Eye................................................................................941 20.3.2 Ocular and Adnexa Injuries...........................................................................942 20.3.2.1 Blunt Injuries....................................................................................942 20.3.2.2 Penetrating Eye Injuries....................................................................943 20.3.2.3 Chemical Injuries to the Eye..............................................................944 20.4 Ocular Tumours.............................................................................................945 20.4.1 Retinoblastoma...................................................................................945 20.4.2 Squamous Cell Carcinoma of Conjunctiva......................................................946 21 EAR,NOSE &THROAT CONDITIONS.........................................947 21.1.1 Foreign Body in the Ear................................................................................947 21.1.2 Wax in the Ear............................................................................................948 21.1.3 Otitis External..............................................................................................949 21.1.4 Otitis Media (Suppurative).............................................................................951 21.1.5 Glue Ear (Otitis Media with Effusion).............................................................953 21.1.6 Mastoiditis..................................................................................................954 21.2 Nasal Conditions...................................................................955 21.2.1 Foreign Body in the Nose............................................................................955 21.2.2 Epistaxis (Nose Bleeding)..............................................................................957 21.2.3 Nasal Allergy................................................................................................958 21.2.4 Sinusitis (Acute)............................................................................................960 21.2.6 Atrophic Rhinitis..........................................................................................962 21.2.6 Adenoid Disease...........................................................................................963 21.3 Throat Conditions.................................................................965 21.3.1 Foreign Body (FB) in the Airway....................................................................965 21.3.2 Foreign Body in the Food Passage.................................................................967 21.3.3 Pharyngitis (Sore Throat)..............................................................................969 21.3.4 Pharyngo-Tonsillitis......................................................................................970 21.3.5 Peritonsillar Abscess (Quinsy)........................................................................971 22. SKIN DISEASES......................................................................974 22.1 Bacterial Skin Infections........................................................974 22.1.1 Impetigo......................................................................................................974 XVIII Uganda Clinical Guidelines 2023 22.1.2 Boils (Furuncle)/Carbuncle............................................................................976 22.1.3 Cellulitis and Erysipelas.................................................................................977 22.2 Viral Skin Infections..............................................................979 22.2.1 Herpes Simplex..........................................................................................979 22.2.2 Herpes Zoster (Shingles)...............................................................................981 22.3 Fungal Skin Infections...........................................................982 22.3.1 Tineas..........................................................................................................982 22.4 Parasitic Skin Infections.........................................................987 22.4.1 Scabies........................................................................................................987 22.4.2 Pediculosis/Lice............................................................................................989 22.4.3 Tungiasis (Jiggers).........................................................................................991 22.5 Inflamatory & Allergic Skin Infections......................................994 22.5.1 Acne............................................................................................................994 22.5.2 Urticaria/Papular Urticari.............................................................................996 22.5.3 Eczema (Dermatitis).....................................................................................997 22.5.4 Psoriasis.......................................................................................................999 22.6 Skin Ulcers and Chronic Wounds...........................................1001 22.6.1 Leg Ulcers...................................................................................................1001 22.7 Drug Induced Skin Reactions.................................................1002 22.7.1 Steven-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)..........1002 22.8 Congenital Disorder.............................................................1004 23 ORAL AND DENTAL CONDITIONS..........................................1005 23.1.1. Halitosis/Bad Breath..................................................................................1005 23.1.2 Dentin Hypersensitivity................................................................................1006 23.1.3 Malocclusion...............................................................................................1006 23.1.4 Fluorosis (Mottling)......................................................................................1007 23.2 Oro-Dental Infections...........................................................1009 23.2.1. Prevention of Dental Caries & Other Conditions Due to Poor Oral lannin....1009 23.2.2 Dental Caries..............................................................................................1010 23.2.3 Pulpitis........................................................................................................1012 23.2.4 Acute Periapical Abscess or Dental Abscess..................................................1013 23.2.5. Gingivitis....................................................................................................1016 XIX Uganda Clinical Guidelines 2023 23.2.5.1 Chronic Gingivitis.....................................................................................1017 23.2.6. Acute Necrotizing Ulcerative Gingivitis (ANUG)/Periodontitis/Stomatitis.....1018 23.2.7 Periodontitis................................................................................................1020 23.2.8 Periodontal Abscess.....................................................................................1021 23.2.9 Stomatitis....................................................................................................1022 23.2.10 Aphthous Ulceration..................................................................................1025 23.2.11 Pericoronitis..............................................................................................1027 23.2.12 Osteomyelitis of the Jaw............................................................................1028 23.3 HIV/AIDS Associated Conditions...........................................1030 23.3.1 Oral Candidiasis..........................................................................................1030 23.3.2 Herpes Infections........................................................................................1030 23.3.3 Kaposi’s Sarcoma........................................................................................1031 23.3.4 Hairy Leukoplakia.......................................................................................1032 23.4 Oral Trauma.......................................................................1032 23.4.1 Traumatic lesions I.......................................................................................1032 23.4.2 Traumatic lesions II......................................................................................1033 23.4.3 Traumatic lesions III.....................................................................................1035 23.5 Oral Tumours......................................................................1036 23.5.1 Burkitt’s Lymphoma....................................................................................1036 24. SURGERY, RADIOLOGY AND ANAESTHESIA.........................1036 24.1 Surgery..............................................................................1039 24.1.1 Intestinal Obstruction...................................................................................1039 24.1.2 Internal Haemorrhage..................................................................................1041 24.1.3 Management of Medical Conditions in Surgical Patient..................................1042 24.1.4 Newborn with Surgical Emergencies.............................................................1045 24.1.5 Surgical Antibiotic Prophylaxis.....................................................................1046 24.2 Diagnostic Imaging...............................................................1047 24.2.1 Diagnostic Imaging: A Clinical Perspective....................................................1047 24.3 Anaesthesia........................................................................1055 24.3.1 General Considerations................................................................................1055 24.3.1.1 General Anaesthesia.................................................................................1057 24.3.3 Selection of Type of Anaesthesia for the Patient...........................................1060 XX Uganda Clinical Guidelines 2023 Preface The Uganda Clinical Guidelines (UCG) evolved from the National Standard Treatment Guidelines 1993, which were the first of the type published in Uganda. Before then, individual guidelines existed to manage a limited number of specific conditions. The purpose of national standard treatment guidelines is to provide evidence-based, practical and implementable guidance to prescribers to provide the most cost-effective and affordable treatment of priority health conditions in a country. Together with the Practical Guidelines for Dispensing at Lower/ Higher Health Facility Level, which provide information about medicine characteristics, administration, and side effects, the UCG is designed as a practical tool to support daily clinical practice by providing a reliable reference for health workers on appropriate management of Uganda’s common health conditions. It also gives health managers a reference tool to assess and measure service quality. The guidelines are also the basis for the formulation of the essential medicines and health supplies list of Uganda (EMHSLU), which is used to guide supply and procurement. This allows for more efficient use of limited resources to improve rational prescribing. The treatments described in the UCG are the nationally recognised standard treatments, and in many cases, they are derived from those recommended in the Ministry of Health Vertical Programmes, World Health Organisation, and other international guidelines. The guidelines have been reviewed and updated through a three-month process involving extensive consultations with public health programs staff, medical experts and health workers of all cadres and various health development partners. XXI Uganda Clinical Guidelines 2023 As medicine is an ever-evolving field, this manual is to be used for guid- ance, but cannot replace clinical judgement in individual cases. The Ministry of Health and all those involved in updating the UCG sincerely hope that the manual will make a significant contribution to ongoing improvements in national therapeutic services and medicines utilisation. Dr. Henry G. Mwebesa DIRECTOR GENERAL HEALTH SERVICES Ministry of Health XXII Uganda Clinical Guidelines 2023 Acknowledgements The UCG 2023 was produced by the Ministry of Health with financial assistance from the World Bank-funded Uganda Reproductive Maternal and Child Health Services Improvement Project (URMCHIP). We extend sincere gratitude to all health workers from the health fa- cilities, academia, Ministry of Health Programmes and Departments, the Uganda National Health Laboratory Services, Regional and District Health Offices, World Health Organisation Country Office, Private-not- for- profit, private for profit organisations and development partners, who have cooperated extensively to make sure the UCG 2023 update is produced in line with national and international guidelines and policies. UCG Taskforce Dr. Olaro Charles (DHS- Clinical Services), Dr. Jackson Amone (CHS- Clinical Services, MOH), Mrs. Okuna Neville Oteba (CHS- Pharmacy), Mr. Morries Seru (ACH - Pharmacy, MOH), Ms. Martha G. Ajulong (ACH – Pharmacy, MOH), Dr. Nakwagala Fredrick (Senior Consultant Physician), Dr. Fualal Jane Odubu (Senior Consultant Surgeon), Dr. Byanyima Rosemary (Senior Consultant Radiologist), Dr. Lakor Francis (Senior Consultant Maxillo-facial Surgery), Dr. Kajumbula Henry (Senior Lecturer- Clinical Microbiology), Dr. Namagembe Imelda (Senior Con- sultant OBS/GYN), Dr. Orem Jackson (Senior Consultant Oncology), Dr. Munube Deogratius (Senior Lecturer Paediatricts), Dr. Wasomoka Alex (ACHS – HLLHFs), Dr. Bahatungire R Rony (PMO – Clinical Ser- vices), Dr. Namwanje Lydia (SMO - Clinical Services), Dr. Katwesigye Elizabeth (Physician, internal Medicine), Ms. Harriet Akello - (Senior Pharmacist MoH DPNM) XXIII Uganda Clinical Guidelines 2023 Contributors to the clinical chapters Dr. Jacqueline Mabweijano, Consultant Surgeon Mulago NRH Dr. Charles Kabugo, Director / Consultant Kiruddu Hospital Dr. Denis Rubahika (MCP-MOH) Dr. Florence Christine Najjuka (Microbiology) Dr. Charles Mondo (Cardiovascular) Dr. J B Waniaye – Emergency and Trauma Dr. John.O. Omagino (Cardiovascular) Dr. William Worodria, Senior Consultant, Mulago NRH Dr. Kalani SMO-MOH, Dr. Francis Lakor, Consultant, maxilla facial surgery Mulago NRH Dr. Dhabangi consultant haematology – Blood transfusion Mulago NRH Dr. Christine Sekaggya-Wiltshire, Physician-Hematologist, Mulago NRH Dr. Henry Ddungu, Physician-Hematologist, UCI Mr. Lule Albert, PNO- Mulago NRH Dr. Patrick Musinguzi, Consultant, Mulago NRH Dr. Abubaker Bugembe, Consultant, Mulago NRH Dr. Jackson Orem, Director, Uganda Cancer Institute Mr. Rodney Tabaruka, Pharmacist Kabale RRH Mr. Emmanuel Ongom, Medical Clinical Officer, Gulu RRH Ms. Martha Ajulong, (ACHS, Pharmacy) Ms. Harriet Akello, Senior Pharmacist MOH Mr. Gad Twikirize, Senior Pharmacist, Butabika NRH Dr. Fualal Jane Odubu, Sen.Cons. -Mulago NRH, Dr. Kajumbula Henry- S/Lecturer, MAK CHS, Dr. Munube Deogratias, Consultant Paed-MNRH, Ms. Atim Mary Gorret - Sen. Pharm-KNRH Dr. Namagembe Imelda, Sen. Cons.- MNRH Dr. Amone Jackson CHS(CS)-MOH Dr. Wasomoka Alex ACHS - HLLHF -MOH Dr. Namubiru Saudah Kizito, Clinical Microbiologist, MOH/NHLDS Dr. Bahatungire Rony, PMO/CS -MOH XXIV Uganda Clinical Guidelines 2023 Mrs. Okuna Neville Oteba, CHS – PNM-MOH Ms. Amuge Beatrice, CHS N&M-MOH Mr. Komakech Alfred, Pharmacist-UCI Dr. Katwesigye Elizabeth, SMO-MOH Dr. Namwanje Lydia, SMO-MOH Dr. Nakwagala Fred, Sen. Cons.-MNRH Dr. Olaro Charles, DHS(CS)-MOH Mr. Seru Morris, ACHS- Pharm-MOH Mr. Opio Patrices Otuke, ASS. DHO/DMMS Mr. Muwonge Raymond, Intern Pharm, Kiruddu NRH Mr. Gidudu Ivan, Dispenser Soroti-RRH Sr. Limio Christine, Mbale RRH-PNO Mr. Sande Alex, Sen. Pharm Mbale RRH Dr. Senjokyo Wilson, M.O Arua RRH Mr. Manzi Mbabazize Gerald, Pharmacist-Mbarara RRH Mr. Katugira Lauben, Pharmacist Mbarara RRH Mr. Obua Thomas O, Sen. Pharm-MOH Mr. Kabonero Timothy, Pharmacist Masaka RRH Mr. Tabaruka Rodney, Sen. Pharm-Kabale RRH Sr. Oyella M. Josephine, Pharmacist-Lacor Hospital Mr. Aguma Daniel, Pharmacist-Lira RRH Dr. Kiwanuka Ivan, SMO-MOH Ms. Twemanye Vivian, Project Pharmacist-IDI/Global Health Mr. Lule Falisy, Pharmacist-Kiruddu NRH Ms. Marion A Murungi - USAID/ MTaPS Mr. Owona Joseph, PCO- Soroti RRH Ms. Irene Bagaya Nurse -IDI Mr. Muwaza Eriabu, Sen. Pharm- Azan-Fort Portal Mr. Gideon Kisuule, P/Pharmacist -Butabika NRH Mr. Bewayo Victor, Pharmacist-Arua RRH Ms. Nyombi Vicky R. Babirye, Sen. Pharm Mulago-NRH Ms. Kahwa Oliva, O.A-MOH Ms. Nanyonga Stella, Sen. Pharm-Mulago Women Hospital XXV Uganda Clinical Guidelines 2023 Mr. Emmanuel Watongola, LSCO-MOH/OPPU Mr. Julius Mubiru, Regional Coordinator MSH Ms. Gladys Karungi, Dispenser-Jinja RRH Ms. Sandra Achiro, Dispenser-Lira RRH Ms. Prossy Atimango, C.O Gulu RRH Ms. Kabonesa Winnie, Dispenser- Mbarara RRH Ms. Namirembe Maliyamu, C.O Masaka RRH Mr. Julius Mayengo, SBO-NDA Dr. Florence Oyella Otim, Paed-Gulu RRH Ms. Nambatya Winnie, Pharmacist-MUK – CHS Ms. Pamela Achii, PSM Specialist-MOH Mr. Mugerwa Ibrahim, PO AMR/GHSA -MOH - NHLDS Mr. Nankoola Dennis, Sen. Pharm -Gulu RRH Ms. Akello Zainab, Pharmacist-Gulu RRH Dr. Okot Christopher, Gen. Surgeon- Gulu RRH Mr. Henry Kizito, SCA-NTLP Ms. Tino Harriet O, Pharmacist-Lira RRH Mr. Olum William, Sen. Pharm-JRRH Dr. Helen Byomire Ndagije, DPS-NDA Dr. Denis Kibira, Coordinator-META Mr. Emmanuel Higenyi, DTS-JMS Ms. Musoke Joanne, META Ms. Namulira John B, SPN-MAK Mr Joseph Mwoga, NPO /EDM-WHO Dr. Otiti Richard, UWEC Dr. Victor Musiime, UWEC Dr. James Ntulume, Snakes Uganda Dr. Alfred Mubangizi ACHS -VB & MTD-MOH Dr. Mukajayaka Ritah, Intern Pharmacist Dr. Nabiryo Mary. Citycare Medical Centre- Jinja Dr. Nakireka Susan Tumwesigye, Mengo Hospital /UNDA Mr. Edson I. Munanura, Secretary PSU Dr. Joanita Bamwanga Nanteza, Physician-Jinja RRH XXVI Uganda Clinical Guidelines 2023 Mr. Ambrose Jakira, SPQS-MOH/DPNM Mr. Rodgers Katusigye, Pharmacist-MJAP Mr. Caroline Birungi, Psychiatrist -MJAP/CHS Dr. Martin Muddu, Physician- MJAP Dr. Musimbaggo Douglas, Coordinator -MJAP Dr. Mugabe Frank, PMO-MOH/MCD Dr. Patricia Alupo, Physician-MLI Dr. Cewa Ssenyange, SDA-NDA Dr. Wabwona George William, Physician-Mubende RRH Dr. Katagira Winceslaus, Physician-Lung Institute Dr. Ann Akiteng, D/Director-UINCD Dr. Lumu William, Physician Diabetologist -MENGO Dr. John B. Kiggundu, Coordinator-IDRC Dr. Ocakacon James, SMO-MOH Dr. Omale William, Sen. Pharm- Arua RRH Mr. Daniel Chans Mwandah, Clinical Pharmacist MRRH/MUST Dr. Kwizera Christopher, Proj. Manager-Uganda NCD Alliance Dr. Isaac Kimera, Coordinator-MJAP Dr. Oyoo Charles A, CHS – NCD-MOH Dr. Gracious Ahumuza, ACHS – PSCL-MOH Dr. Nantaba Deborah, MCO/Selfcare Trainer-MDLG Ms. Jacqueline Twemanye, Comms Officer-CEHURD Dr. Kimbowa Richard, MDRH Dr. Kukundakwe Annah, SPO-CEHURD Ms. Awilli Grace, Volunteer-CEHURD Dr. Nsingo Simon Peter, M.O-Mukono C.O.U Hospital Dr. Isaac Ssinabulya, Cons. Cardiologist-UHI/UINCD Ms. Kironde Stella M, PHO- Komamboga HCIII Mr. Pascal Aliganyira, SCO-SAMASHA Dr. Christopher Arineitwe, NFPP Advisor- USAID FPA Ms. Aruho Carol, Proj. Officer-HEPS UG Ms. Precious Mutoni, Advocacy & Partnership-PSI Uganda Ms. Joyce Zalwango, Ag. Programs Manager-PCAU XXVII Uganda Clinical Guidelines 2023 Dr. Karima Amin Kamru K, Head-MPU -Hospice Africa Uganda Mr. Ogwang Christopher, SPO-CEHURD Dr. Niwagaba Peter, Technical Advisor, SCM-USAID RHITES EC Mr. Lubogo Patrick, Clinical Pharmacist Mr. Tadele Mekuriya Yedesa Clinical Pharmacist - Mbarara RRH Mr Aboda Alex Komakech Clinical Pharmacist - Kitgum District Hospital Dr. Isiiko John, Oncology Pharmacist - Mbarara RRH, Mr. Aguma Bush Herbert, Makerere University, School of Pharmacy, Ms. Farida Khaukha. Pharmacist-NDA Mr. Dennis Rogers Buwembo-Consultant R4D. Mr. Patrick Mpiima, Registrar-Allied Health Professionals Mr. Eric Jemera Nabuguzi, Principal Advisor, RMNCH Mr. Lawrence Were, - RCHSC/TA-CHAI Dr. Hafsa Lukwata, Mental Health/MOH Dr. Benjamin Mwesige, Pharmacist, UCI Dr. Martin Ssendyona, Quality Assurance/MOH Dr. Fatunmbi Bayo Segun, WHO, Dr. Patrick Tusiime, NDC/MOH, Dr. S. Nanyonga, Jinja, Dr. J. Ddamulira, MUSPH, Makerere. Dr. Suuna Micheal, Dr. D Musingo, Dr. Turyahabwe Stavia, ACHS-NTLP/MOH Dr. Henry Luzze, PMO -NTLP/MOH Dr. Winters Mutamba, Consultant -MLI Dr. Aldo Burua, TB case finding Advisor - NTLP/ LPHS Ms. Hawa Nakato, Supply Chain Advisor -NTLP/MOH Mr. Abdunoor Nyombi, Lab – NTRL - NTLP/MOH Dr. Jeff Amanya, Epidemiologist - NTLP/MOH Dr. Joshua Muhumuza, PPM Advisor - NTLP/ LPHS Dr. Simon Muchuro, TB Prevention Advisor -NTLP/ LPHS Mr. Muzamir Bamuloba, CSS Advisor - NTLP/MOH Dr. Mary Mudiope, Project Director - LPHS TB Activity Dr. Prossy Namuwenge, SPO TB/HIV - ACP/MOH Mr. Ebony Quinto, M&E - NTLP/MOH XXVIII Uganda Clinical Guidelines 2023 Dr. Raymond Byaruhanga, STA-Global Fund - NTLP/MOH Ms. Shamimu Masika, Adm Assistant - LPHS TB Activity Mr. Busingye Evas, IT Officer - NTLP/MOH Dr. Ajuna Patrick , TB DSD Advisor - NTLP/MOH Mr. Kamara Vincent, Data Manager - NTLP/MOH Mr. Didas Tugumisirize, Laboratory Technologist - NTLP/MOH Mr. Ignatius Senteza, STA LPHS- TB Activity Mr. Moses Arineitwe, TA-M&E - NTLP/MOH Dr. Gemagaine Godfrey, Cons. Pathologist-Naguru Hospital Dr. Susan N. Nabadda, CHS-NHLDS- UNHLS/CPHL- MoH Dr. Sam Kalungi Dr. Achola Caroline Dr. Kubengi Henry Mr. Kenneth Mwehonge - HEPS-Uganda, ED. Mr. Serunkuuma Richard-Positive Men’s Union, ED Ms. Jackline Mutimba - HEPS-Uganda, Senior M&E Officer Ms. Bridget Jjuuko - ACTS101, ED Ms. May Ndagire - Preventive Care International, Programs Officer Mr. Peter Eceru – CEHURD- Program Coordinator Mr. Okoth Charles - AWAC, CMO Mr. Ssebibubbu Stuart - HEPS-Uganda, Pharmacist Mr. Bukenya Denis Joseph - HURIC Ms. Joan Esther Kilande - HEPS-Uganda, Health Policy Advocacy Manager Ms. Mable Kukunda Musinguzi – UNHCO, Head of Advocacy and net- working Mr. Talibita Moses – UNHCO -Legal Officer Ms. Kangabe Claire - Transparency International Uganda Ms. Ninsiima Dorothy - Action Group for Health, Human Rights & HIV/ AIDS Executive Associate Ms. Nanteza Ruth - Uganda Young Positives (UYP), Peer Leader Mr. Principle Edimon - Vision Group, Journalist Mr. Gilbert Musinguzi - Uganda Debt Network (UDN)-Quality Assurance Manager Ms. Nabirah Namawanda - Lady Mermaid Empowerment Center, Com- munication & Advocacy Officer XXIX Uganda Clinical Guidelines 2023 Mr. Jude Opolot - Oxygen Task Force Logistician, MoH Ms. Doreen Nyakato - Oxygen Task Force Coordinator, MoH Dr. Samalie Namukose (Assistant Commissioner, Nutrition Division, Ministry of Health) Dr. Alex Mokori (Nutrition Specialist, UNICEF) Ms. Jeniffer Luande (Nutrition Supply Chain Consultant, UNICEF) Mr. Tim Mateba (Senior Nutritionist, Nutrition Division, Ministry of Health) Dr. Hanifa Bachu (Technical Director Nutrition, USAID MCHN Activity) Dr, Elizabeth Kiboneka (Nutrition Consultant) Mr. George Kemugisha (Nutritionist, Mulago National Referral Hospital) Ms. Amanda Murungi (Nutritionist, Mulago National Referral Hospital) Ms. Agnes Kiro (Programme Officer, Nutrition Division, Ministry of Health) Dr. Anne Mary Nanyonjo - Pharmacist Mubende RRH Mr. Absolom Zisanhi - Senior Associate, CHAI Dr. Margaret Abigaba - Senior Pharmacist, Hoima RRH Mr. Michael Lukunyanga - Distribution manager, NMS Dr. Emily Tumwakire - Senior Medical Officer, MoH Ms. Dorcas Kemigisha - Senior Coordinator, CHAI Eng. Owen Muhimbise - Biomedical Engineer, MoH Blasio Kunihiira - M&E coordinator, CHAI Eng. Saad Waigonda - Senior Biomedical Engineer, MoH Eng. Tadeo Byabagambi - ACHS-Biomedical/Electromechanical Engi- neering, MoH Dr. Yewande Kamuntu, Program Manager, CHAI Dr. Santa Engol, Senior Coordinator, CHAI Dr. Aanyu Hellen, Consultant Pediatrician, Mulago NRRH Mr. Jovan Baryamujura, Oxygen Task Force Administrator Ms. Nakade Shamim – National Activity Manager SSCS Activity Mr. Daniel Mawerere – Senior Technical Advisor MoH DPNM Mr. Kasule Timothy – RHSC Analysts UNFPA Mr. Joel Miti - Senior Technical Advisor NMCD MoH Ms. Magona Sandra RMNCAH & Nutrition Senior Technical Officer MoH DPNM Ms. Sarah Taratwebirwe, Condoms Logistics Management Officer MoH DPNM XXX Uganda Clinical Guidelines 2023 Mr. Tabu Fred – Senior Technical Officer MoH DPNM Mr. Ian Nyamitoro, HP Quantification Specialist MoH DPNM Mr. Deogratius Kamulegeya - Administrator, IMT Logistics Pillar, MoH Mr. Ambrose Jakira, HP Quantification Specialist MoH DPNM Mr. Isaac Namoma, GHSA Senior Technical Officer USAID/SSCS Activity Ms. Judith Kyokushaba, Laboratory Advisor MoH DPNM Mr. Henry Oundo, Technical Advisor MoH DPNM Ms. Linacy Nampa, Technical Advisor MoH DPNM Mr. Emiku Joseph, HIV/TB Tec

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